Description:
This session explores the interface of skin and psyche. There are four different ways the mind and the skin can interact that are most relevant to practicing dermatologists. First, primary psychiatric conditions are involved when the skin is normal, but because of the patient's underlying psychopathology, self induced lesions occur. This category includes delusions of parasitosis, factitial dermatitis and trichotillomania. Second category is termed psychophysiologic conditions whereby bona fide skin conditions are made worse by psychological stress. This category includes psoriasis, atopic dermatitis, acne and many other conditions including those that involve chronic and recurrent inflammatory process. The third category involves psychological negative impact that patients experience as a consequence of having a disfiguring skin condition. The patients may experience many different types of psychological difficulties including social phobia, generalized anxiety disorder, depression, etc. Lastly, there is a fourth category termed cutaneous sensory disorder where the patients experience uncomfortable sensations ranging from burning, itching, crawling, biting, and stinging sensations without diagnosable underlying medical condition or visible cutaneous pathology. These patients are often helped by the use of anti-depressants with analgesic property such as tricyclic anti-depressants in low doses. This session will cover the entire spectrum of the interface between skin and psyche, emphasizing practical information usable in a dermatologist's busy daily practice.